Provider Demographics
NPI:1013193069
Name:WOOSAM, PHILLIP OSWALD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:OSWALD
Last Name:WOOSAM
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Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:5453 GULF DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3903
Mailing Address - Country:US
Mailing Address - Phone:727-847-2214
Mailing Address - Fax:727-846-0923
Practice Address - Street 1:5453 GULF DR
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3903
Practice Address - Country:US
Practice Address - Phone:727-847-2214
Practice Address - Fax:727-846-0923
Is Sole Proprietor?:No
Enumeration Date:2008-01-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant